Health Literacy Universal Precautions Toolkit, 2nd Edition

Create a Health Literacy Improvement Plan: Tool #2

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Your Health Literacy Team will need to decide which health literacy-related improvements to work on first. The Primary Care Health Literacy Assessment will help you examine how your practice is performing in key areas that influence patient understanding, navigation, and self-management. After identifying aspects of your practice that are priorities for improvement, you can create a Health Literacy Improvement Plan to implement the tools that will help you improve.


Review the Primary Care Health Literacy Assessment in a Health Literacy Team meeting.

The Primary Care Health Literacy Assessment form.

  • Collect assessment data. Ask each member of the Health Literacy Team to complete the Primary Care Health Literacy Assessment. (It takes less than 30 minutes.) You can also broaden the exercise by asking everyone in your practice to complete the Assessment. For large numbers of respondents you may find it easier to use a template available from SurveyMonkey®. Make sure everyone has the same understanding of each question. Note that a few questions will require staff to "walk through" the practice and see it from a patient's point of view.
  • Discuss responses. Have team members bring their completed assessments to a team meeting. If using the SurveyMonkey® template, you can import results into a spreadsheet and tally them before the meeting.
  • Discuss opportunities for improvement. You may want to begin by identifying questions commonly answered "Needs Improvement" or "Not Doing," or those for which there is wide variation in responses, as these may represent potential opportunities for improvement.
Practice Experiences
Many practices have found the health literacy assessment to be beneficial. Here are some typical comments:

  • "The assessment increased our attention to areas not previously identified as concerns, like the signs in our practice. We just don't think of those things every day."
  • "Before doing the assessment, we had an idea about what tool we wanted to try. But after discussing our assessment questions, we completely changed our selection."
  • "We liked the assessment process, and when we looked at our answers, our priorities just lit up."

Develop a Health Literacy Improvement Plan.

  • Set your health literacy improvement goals. The choice may be based on the results of your assessment, on specific aims your practice has, on practice improvement efforts already underway, or a desire for an "easy win" to jump-start this quality improvement process.
  • Use the Primary Care Health Literacy Assessment to identify the tools that will best facilitate improvement in the areas of weakness you have identified. The Health Literacy Team should read your chosen tools carefully.
  • Decide how you will implement the tools you have chosen. Check that the changes you plan to make can reasonably be expected to achieve your goals.
  • Develop a clear and written action plan that will ensure the Health Literacy Team remains on the same page throughout implementation. Use the Plan-Do-Study-Act (PDSA) method to help you create your action plan. In this Toolkit's appendix is an explanation and directions for this type of change model along with a PDSA worksheet that can help you plan your changes. For more information about quality and process improvement strategies, go to The Model For Improvement: Your Engine For Change Web site.
  • Define who will be responsible for implementing changes.
  • Set time-specific, achievable objectives.
  • Establish measures to assess whether your objectives are being met. Specify when and how you will collect data for these measures, remembering that you may want to collect information before and after you begin tool implementation. Note that each tool in this Toolkit provides suggestions for establishing these important measures.

Prepare for implementation.

  • Before beginning your implementation efforts, educate your staff about health literacy and the changes you are planning. Use resources provided in Tool 3: Raise Awareness to provide staff with basic health literacy instruction.
  • Present the results of the practice assessment and Health Literacy Improvement Plan to the entire practice. This is an opportunity to get additional input and buy-in from others in the practice and to provide initial education on health literacy.
  • Building Health Literate Organizations: A Guidebook to Achieving Organizational Change can help you identify ways of engaging practice leadership and preparing your staff for organizational change.
  • Work out the kinks on a small scale before implementing changes practice-wide. Using PDSA cycles can help you in this process.
  • Have a plan for spreading successful changes throughout the practice. Improvements will not be adopted throughout your practice without a concerted effort to get everyone on board.

Sustain your efforts.

  • Share the results of your progress assessments with practice staff to maintain awareness of health literacy-related issues and build continuing enthusiasm for your quality improvement efforts.
  • Establish a routine schedule for updating practice leadership on activities and accomplishments.

Track Your Progress

After implementing one or more tools for 3-6 months, examine practice processes to see if they are now a regular part of care throughout the practice.

Use the Primary Care Health Literacy Assessment to re-assess your practice at regular intervals (e.g., twice a year). Doing so will help you confirm areas of improvement and identify new goals and objectives to update your Health Literacy Improvement Plan.

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Page last reviewed February 2015
Page originally created February 2015
Internet Citation: Create a Health Literacy Improvement Plan: Tool #2. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD.
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